Transfusion Medicine, School of Medicine, University of Málaga, Campus de Teatinos, 29071 Málaga, Spain.
Br J Anaesth. 2010 Oct;105(4):457-65. doi: 10.1093/bja/aeq174. Epub 2010 Jul 16.
Salvage and return of unwashed shed blood (USB) after total knee replacement (TKR) is an established blood-saving technique, but some authors question its efficacy and safety and suggest that the shed blood be washed before returning. We evaluated a colloid-based sedimentation method for improving and standardizing the quality of USB collected after TKR without the need for washing.
Experiments were performed to find the optimal colloid dose and sedimentation time using diluted donated venous blood. USB samples (n=52) were drawn from the reinfusion bag and mixed with hydroxyethyl starch or gelatine solutions (15-30%, colloid solution volume/total volume × 100). USB red blood cells (RBCs) were allowed to settle by gravity for 30 min, supernatant was evacuated from the syringe, and RBC concentrate was analysed. RBC recovery and other blood cell and chemical removal were calculated according to changes in USB volume and haematocrit. Twenty-five samples from leucodepleted packed RBCs were analysed as a comparator group.
Mean haemoglobin (Hb) of USB was 10.9 g dl(-1). After colloid treatment, 90% of RBCs were recovered, and USB Hb was similar to that of leucodepleted packed RBCs (n=25) (18.9 vs 19.6 g dl(-1), respectively; P=NS). In addition, the procedure reduced USB content of leucocytes (60%), platelets (48%), total protein (76%), cytokines (70-77%), and plasma-free haemoglobin (53%), without major differences between colloids.
Sedimentation of USB with colloid solutions provides a low-cost alternative for improving and standardizing the quality of salvaged USB after TKR.
全膝关节置换术（TKR）后回收未洗涤的失血（USB）并返回患者体内是一种已确立的节约血液的技术，但一些作者对其疗效和安全性提出质疑，并建议在返回前对失血进行洗涤。我们评估了一种基于胶体的沉淀方法，用于在不洗涤的情况下改善和标准化 TKR 后收集的 USB 的质量。
使用稀释的捐赠静脉血进行实验以找到最佳胶体剂量和沉降时间。从再输注袋中抽取 USB 样本（n=52）并与羟乙基淀粉或明胶溶液（15-30%，胶体溶液体积/总体积×100）混合。允许 USB 红细胞（RBC）通过重力沉淀 30 分钟，从注射器中抽出上清液，并分析 RBC 浓缩物。根据 USB 体积和血细胞比容的变化计算 RBC 回收率和其他血细胞及化学物质的去除率。分析 25 份白细胞去除浓缩红细胞样本作为对照组。
USB 的平均血红蛋白（Hb）为 10.9 g dl(-1)。经过胶体处理后，90%的 RBC 得到回收，并且 USB 的 Hb 与白细胞去除浓缩红细胞（n=25）相似（分别为 18.9 和 19.6 g dl(-1)；P=NS）。此外，该程序降低了 USB 中白细胞（60%）、血小板（48%）、总蛋白（76%）、细胞因子（70-77%）和血浆游离血红蛋白（53%）的含量，两种胶体之间没有显著差异。
使用胶体溶液沉淀 USB 为改善和标准化 TKR 后回收的 USB 质量提供了一种低成本的替代方法。
